New research reported by Keith Rollag, an expert on leadership and organizations, in Harvard Business Review, suggests that in new situations, “the more questions new employees ask and the more help they seek, the better they perform” and that executives looking back on their first few months on the job commonly regret not asking more questions. For his book, What to Do When You’re New, Rollag interviewed people in a variety of professions entering different kinds of groups — joining companies, hospitals, and schools, but also churches, yacht clubs, rock bands, and retirement communities.
As a starting place, reading Rollag’s HBR article offers great advice for any newcomer. In the medical world, residents and fellows have the advantage of starting someplace new with a group of peers and going through an orientation and training process together, but physicians in practice — whether you’re a trainee in a big program or a solitary physician at a new hospital — often have to go it on their own. Keith Rollag’s expertise here definitely applies. I conducted an interview with him via email and four themes emerged: general tips for physicians dealing with new situations, distinct challenges for those in hospitals, ways to approach the patient encounter, and how to get better at remembering names (a universal problem).
Josette: How Can Physicians Succeed in New Situations?
Keith: Being new is a universal challenge, regardless of the profession. We’re hardwired to be nervous around strangers, and the high-stakes stress of the hospital environment only makes it worse.
Here are three essential tips when you’re starting out:
1. Accept your newcomer anxiety as normal. Acknowledge your nervousness and push past it to focus on learning your new role and building the relationships you need to be successful.
2. Introduce yourself to the people you need to know to be successful in your new role. Don’t assume your hospital administrator will make all of the introductions you need. Recognize that the key relationships you need extend far beyond your immediate team to include specialists and support staff throughout the hospital.
3. Focus on learning. You will feel the demands to perform well from day one; however, approaching your new role with a learning mind-set offers several advantages. Asking questions helps you get up to speed quickly and makes a good first impression by showing respect and humility. This is true for both new physicians and for seasoned physician leaders wanting to jumpstart productive relationships with their support staff.
What Are the Distinct Challenges for Newcomers in the Hospital Environment?
The hospital — where the primary mission is to save lives — is different in some ways. The majority of interactions in hospitals are task-focused. It’s a fast-paced, demanding environment with little time for new doctors and nurses to get to know their coworkers. Whereas the demands of the job force newcomers to get up to speed quickly, the lack of focused relationship building may cause them to find that it takes longer to feel truly connected to their new coworkers and organization than it might in a more relaxed work environment.
Patient care is a team-effort where tightly coordinated action is required and mistakes can be fatal. Once a team builds a high degree of trust and efficiency, the arrival of a new member can disrupt well-honed routines, and the veterans may be less forgiving of newcomer missteps. This can make it much harder (or at least more stressful) for a new doctor to become a productive, accepted member of their new group.
I’ve talked to many organizations that have a cohort of new employees arriving at the same time. Some do a very good job of providing formal orientation and training activities that help new employees get up to speed. These activities also help the newcomers get to know each other, which gives them a ready-made support group of others in the same situation. Some help newcomers find mentors or buddies who can really help new hires get the information and support they need.
Here are four tips for those starting out at a hospital:
1. Ask questions. In a task-based, high-pressure environment like a hospital, many rookie mistakes come not from incompetence but from a reluctance to ask all the questions they need to make an informed decision. Rather than risk looking incompetent by asking questions, new doctors make assumptions and act based on what they already know, which is often a dangerous strategy. While sometimes veteran doctors and nurses might be annoyed by the interruption, most team members expect and are willing to answer questions, especially if it will prevent future problems or issues and get the new doctor up to speed quickly.
2. Focus on building trust. In a fast-paced, high-stress medical environment, trust is essential. Patients and nurses need to trust the decisions of doctors. Doctors need to trust the decisions of other doctors. While team members may welcome you with a certain amount of trust, most of it has to be earned over time through what you say and do. Some things that help build trust include:
a. Always being honest and upfront in your interactions with others
b. Admitting when you don’t know something
c. Following through on your promises and commitments.
3. Leave the ego at home. Arrogance is almost always detrimental to working relationships, and can keep you from really being accepted by your new team.
4. Be helpful. One of the best ways to make a good impression is to be helpful in ways that go beyond your job responsibilities. Don’t see some tasks as beneath you — when there is a need, jump in and provide the kind of help you would want others to give.
Is Each Patient Encounter Unique?
Physicians and patients have role-defined, specific assumptions about how the interaction will go, what they will likely say, and how they will likely interact. In that sense each patient encounter is not a new situation at all. However, if both doctor and patient play their respective roles without thinking, they might overlook something unusual that could be important for diagnosis and optimal patient outcomes. This is why improving physician communication skills with patients is so important in the medical education world.
Approach each patient with a genuine interest in not only diagnosing the ailment but learning something new about the other person. Patients want to be seen as human beings and not as a machine to be fixed. Focus on both the ailment and the person (even for a few moments), and you’re more likely to show the empathy and caring that will make a positive impact on the patient.
What Makes Remembering Names So Important — and How Can Physicians Improve at this Skill?
A person’s name is one of the most unique and important parts of their identity, and remembering someone’s name sends huge signals about how much you respect and care about them. Conversely, blanking on someone’s name after meeting them a few times (especially someone you recently met) can send the signal that either you don’t care or feel it isn’t important enough to learn their name in the first place.
While it might be easy to quickly learn and remember the names of people you interact with every day, it’s much harder for those you only see occasionally at conferences and medical education courses. Even so, there is still an expectation you’ll be able to pull their names quickly out of memory when you run into them again.
For physicians encountering patients, appointment schedules and medical charts are both a benefit and crutch. By reviewing them in advance of a patient interaction (often only a few seconds before seeing them) they “prime” the doctor to recall and use the name effectively. But if a doctor comes to rely on schedules and charts to prompt their recall, they may never make the effort to really learn the name in the first place. Eventually the doctor will run into the patient outside of a planned appointment and he or she will inevitably blank on the name. Patients understand that doctors have hundreds or thousands of patients and don’t expect all of them to remember — our brains simply aren’t hardwired to do this well — but after enough interactions one hopes the name will stick.
The more people in your life you can call by name (including co-workers, administrators, janitorial staff, as well as life-long patients) the better and more effective the relationship you’ll have with them.
Here are three tips on remembering names:
1. Make a commitment to listen carefully to their name. Researchers have found that when we blank on a name, it’s often because we didn’t pay enough attention to it when we heard it (often at the beginning of an introduction). Remind yourself to listen, and make it a habit to repeat their name right away to get it into memory. Mentally test yourself on their name as you talk with them, and ask for it again at the end of the conversation if you’ve already forgotten it.
2. Write it down. As soon as you can after the introduction, write it down (or put it in your phone). The act of writing will help get the name into long-term memory, and if you carry your lists of new names with you can often sneak away and look at your list when you find you’ve forgotten someone’s name. Our ability to recognize the right name is far better than our ability to pull that name out of memory in the heat of the moment.
3. Prime yourself before you meet them again. While sometimes we find ourselves suddenly running to people we’ve met, often we know who will be at meetings, conferences, etc. Reviewing their names in advance can re-charge the neural pathways to their name and significantly increase the chance you’ll recall it when you need it.
Keith Rollag is an Associate Professor at Babson College, where he teaches leadership and organizational behavior. His book, What to Do When You’re New, is designed to help people become more comfortable, confident, skillful newcomers.